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A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I

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Chiari Malformation Type I (CM1) is characterized by the downward displacement of the cerebellar tonsils below the foramen magnum. The standard surgical treatment for CM1 is foramen magnum decompression and atlas laminectomy (FMD-AL). However, there is a growing interest in exploring minimally invasive techniques, such as neuroendoscopically assisted FMD-AL, to optimize surgical outcomes. The aim is to present the results of the less invasive neuroendoscopic-assisted system application as an alternative to decompression surgery in patients with CM-1 with/without syringomyelia.

Patients and methods

A retrospective analysis was conducted on 76 patients with CMI who underwent either neuroendoscopic-assisted FMD-AL (n = 23) or open surgery (n = 53). Preoperative and postoperative assessments were performed, including pain levels, functional assessment, outcome and serum creatinine kinase (CK) levels. Surgical parameters and radiological imaging were also evaluated and compared.


Both surgical groups showed improvements in pain levels and increase in postoperative CK levels. There were no statistically significant differences between the groups in terms of postoperative JOA scores, VAS scores, CCOS, or syrinx resolution. However, the neuroendoscopic group had significantly lower CK levels, shorter hospital stays, less blood loss, and shorter operation times compared to the open surgery group, indicating reduced muscle damage and potential benefits of the neuroendoscopic assisted approach.


Both neuroendoscopy and open surgery groups can effectively alleviate symptoms and improve outcomes in patients with CM1. The neuroendoscopic assisted technique offers the advantage of reduced muscle damage and shorter hospital stays. The choice of surgical technique should be based on individual patient characteristics and preferences.

Level of evidence

3 (Retrospective case–control study) according to using the Oxford Centre for Evidence-Based Medicine (CEBM) Table.

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Availability of data and materials

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.


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This research received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations



Conceptualization: GG, EÇ; Methodology: GG, EÇ, ZD; Formal analysis and investigation: EÇ, ZD; Writing-original draft preparation: EÇ, ZD; Writing-review and editing: AD, ADB; Funding acquisition: AD; Resources: GG; Supervision: ADB.

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Correspondence to Göksal Günerhan.

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The authors declare no conflicts of interest or competing interests.

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All authors provide their consent for the publication of the study.

Consent to participate

Written signed informed consent was obtained from all patients who participated in the study, both for their involvement and for the surgical intervention. The risks and benefits of the procedure and the study were explained in detail.

Ethics approval

Ethics committee approval for this article was obtained from the Ministry of Health, Provincial Health Directorate, Clinical Research Ethics Committee No. 1, with the number E1-22-2650.

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Günerhan, G., Çağıl, E., Dağlar, Z. et al. A comparative analysis of neuroendoscopic foramen magnum decompression versus traditional open surgery for Chiari Malformation Type I. Eur Spine J (2024).

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